Provider Demographics
NPI:1215617907
Name:GILLIAM-ELLIOTT, CANDI Y (LSW)
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:Y
Last Name:GILLIAM-ELLIOTT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CANDI
Other - Middle Name:Y
Other - Last Name:GILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:9249 S BROADWAY STE 200-206
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-5690
Mailing Address - Country:US
Mailing Address - Phone:720-507-3189
Mailing Address - Fax:
Practice Address - Street 1:9249 S BROADWAY STE 200-206
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-5690
Practice Address - Country:US
Practice Address - Phone:720-507-3189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000000848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker